RCS hails landmark publication of individual surgeons’ outcomes data

Info

28 June 2013

Royal College of Surgeons hails landmarkpublication of individual surgeons’ outcomes data as a watershed moment for surgery

Approximately 3,500 surgeons have achieved a world first, by publishing their individual surgical results. The innovative move will drive forward improvements in care and enable patients to understand far more about the nature of a surgeon’s work and their recovery after an operation.

For the first time, patients and the public will be able to read information which gives details of a surgeon’s performance by looking at the outcomes of particular procedures or operations, such as a hip replacement or surgery for obesity.

The measurements, based on national clinical audits, are a way of measuring performance against a set of professional standards relating to survival rates, length of stay in hospital following a procedure and repeat operation rates, as well as the number of operations performed.

Over a period of only six months and in the largest undertaking of its kind, thousands of surgeons have prepared and checked data based on the results of NHS operations carried out over the past three years. The publication of these data is the beginning, and it is important that the data are robust and reliable so the results are as accurate as possible.

The exercise found that the overwhelming majority of surgeons are performing operations and procedures to a high standard set by their own professional surgical specialties. Only a handful of surgeons appear as ‘outliers’ where their results are significantly different from others, and where further investigation to understand these data is needed.

More than 20 surgical procedures are covered in the information, which will be placed in the public domain from Friday, 28 June 2013 on the NHS Choices website, and on the websites of individual surgical specialty associations.

Professor Norman Williams, President of the Royal College of Surgeons, said:‘This is an historic moment for surgery, and I’m enormously proud of what surgeons up and down the country have achieved. It has been a difficult and complex undertaking carried out in a short timescale, but we see this as the beginning of a new era for openness in medicine. It is early days, but it will change for the better the nature of the bond between patient and surgeon, which is based on both openness and trust.

Clinical audits are a way of measuring performance, but it is really important that any analysis of the work of surgeons who take on higher risk patients, such as those with complex health needs like diabetes or respiratory problems, must reflect the complexity of these conditions. We must not deter surgeons from treating difficult cases for fear of being penalised.'

Professor Williams added: ‘We hope patients understand and see that their outcomes do not depend on one individual, they depend on the entire team and the structure in which they work. That’s why the publication of data at a unit or team level is also vitally important.’

NHS England’s commitment to providing patients with more public information about their care is one the College wholeheartedly supports. The RCS highlights that the shift towards greater transparency within surgery will enable patients to have more informed conversations with their consultant about the quality of their care.

Gill Humphrey, Chair of the Royal College of Surgeons Patient Liaison Group, said: ‘Publishing consultant-level results is good news for patients. It will allow them to see how many operations their surgeon has undertaken and their outcomes, and will provide surgeons with greater opportunity to learn from each other and strive to improve.’

The successful publication of outcomes data for heart surgery has already shown how this level of information can drive up standards in the NHS. However, the College warns that good quality data are crucial to this process.

More than 99% of surgeons consented to the use of their data, with fewer than 30 not consenting, mainly because of concerns about the quality of data and risk-adjustment issues. The names of non-consenters will be listed on the NHS Choices website along with their reasons for taking this action. It is understood that none of the non-consenters are ‘outliers’.

All data has been analysed by the surgical specialty associations to work out the appropriate standard for a surgeon, and to define acceptable and unacceptable variation from best practice. Where a surgeon appears to be an outlier their data will be checked and re-examined to ensure the appropriate risk-adjustment has taken place. Once this has been done, if the surgeon is a true outlier each surgical specialty has a process in place to provide support and additional training where necessary.

Notes to editors

Publication of surgeon-level data is, at present, a requirement of NHS England. Many of the surgical specialty associations are UK-wide and may decide to make data available on surgeons working outside of England, information which will be available on specialty association websites. It will be up to the Governments in the devolved nations to decide whether publication should be mandated.

Most surgical specialities cover a wide range of operations, and at this stage, the published data only covers a small number of these procedures. The selection process takes into account factors such as what procedures are currently covered by audit/registry; how frequently the procedure is undertaken; and whether it is considered a good indicator of skill. For example orthopaedics have chosen to look at hip and knee replacement surgery.